Tjf 180

The endoscopic procedures were performed by faculties and attendants of Jena University Hospital, Clinic of Internal Medicine IV, who were highly experienced in pancreaticobiliary procedures. Tissue acquisition was performed with brush cytology and if feasible an additional fluorescence guided forceps biopsy was taken. ERC was performed using the standard technique with a single type of duodenoscope (TJF 180, Olympus, Tokyo, Japan). First, cannulation of the common bile duct (CBD) and endoscopic sphincterotomy were performed. After gaining access to the biliary tract, the “Cytomax II Double Lumen Cytologie Brush” (Wilson-Cook Medical Inc., Winston-Salem, Irland) was placed over a Jagwire .035/450 Guidewire (Boston Scientific Corporation, 300 Boston Scientific Way Marlborough, MA) inside its sheath under fluoroscopic guidance above the stricture. Once the brush was released out of its sheath, tissue sampling began moving it back and forth repeating this maneuver with a minimum of five passages. Then the brush was pulled back into the sheath and pulled out as a single unit. Crossing the brush over the stricture was performed without prior dilatation of the stricture. If possible, a fluorescence guided forceps biopsy (Biopsy forceps, Jiangsu Kangjin Medical Instrument Co., ltd; Zhenglu Town, Chang Zhou, China) was taken.

All procedures were performed under general anesthesia. Side-viewing endoscopes (TJF-160 or TJF-180; Olympus America, Melville, NY, USA) were used for the ERCP. The 15-cm double pigtail stents of varying diameters (5 to 10 Fr) were used for stenting the cystic duct (Cook Medical, Winston-Salem, NC, USA). Conventional curvilinear array oblique-viewing therapeutic echoendoscopes were used for EUS-GBD (GF-UCT 180; Olympus America). Fully covered self-expanding metal stents with anti-migratory fins (FCSEMS-AF; Viabil; Conmed, Utica, NY, USA) were placed transluminally. Antibiotics were administered empirically.

Endoscopists who performed the endoscopic procedures all had extensive experience in endoscopic management of chronic pancreatitis, each having done more than 1000 ERCPs. Side-viewing endoscopes (TJF-180, TJF-160, Olympus America, Center Valley, Pennsylvania, United States) were used for all procedures. Pancreatic sphincterotomy was performed on all patients before FCSEMS placement. The pancreatic stricture was dilated with either a 4-mm or 6-mm balloon dilator (Hurricane, Boston Scientific, Natick, Massachusetts, United Sates), then, over a 0.035-inch guide- wire, an 8-mm-diameter or 10-mm-diameter FCSEMS (Wallflex, Boston Scientific Corp, Natick, Massachusetts, United States) was placed in the main PD across the stricture (
Fig. 1); the length of the stent was determined by the length of the stricture. Biliary sphincterotomy was performed at the same time if no prior one was performed. The FCSEMSs were removed after a period of at least 3 weeks with snare or rat-tooth forceps and pressure injection was performed to confirm pancreatic drainage after stent removal.

All procedures were performed by one of three adult gastroenterologists experienced in ERCP under either deep sedation or general anesthesia with the help of an anesthetist. A standard adult duodenoscope (Olympus TJF 180; Olympus, Tokyo, Japan) was used for all procedures. The technique and accessories used were similar to those routinely used in adult patients. All the patients were hydrated with intravenous fluids during and after the procedure, and rectal non-steroidal anti-inflammatory drugs were administered to patients deemed to be at high risk of post-ERCP pancreatitis (PEP) [7 (link)].